Global dissociation of the amygdala from the rest of the brain during REM sleep

Rapid-eye-movement sleep (REMS) or paradoxical sleep is associated with intense neuronal activity, fluctuations in autonomic control, body paralysis and brain-wide hyperemia. The mechanisms and functions of these energy-demanding patterns remain elusive and a global picture of brain activation during REMS is currently missing. In the present work, we performed functional ultrasound (fUS) imaging at the whole-brain scale during hundreds of REMS episodes to provide the spatiotemporal dynamics of vascular activity in 259 brain regions spanning more than 2/3 of the total brain volume. We first demonstrate a dissociation between basal/midbrain and cortical structures, the first ones sustaining tonic activation during REMS while the others are activated in phasic bouts. Second, we isolated the vascular compartment in our recordings and identified arteries in the anterior part of the brain as strongly involved in the blood supply during REMS episodes. Finally, we report a peculiar activation pattern in the amygdala, which is strikingly disconnected from the rest of the brain during most but not all REMS episodes. This last finding shows that amygdala undergoes specific processing during REMS and may be linked to the regulation of emotions and the creation of dream content during this very state.

Global dissociation of the amygdala from the rest of the brain during REM sleep

Rapid-eye-movement sleep (REMS) or paradoxical sleep is associated with intense neuronal activity, fluctuations in autonomic control, body paralysis and brain-wide hyperemia. The mechanisms and functions of these energy-demanding patterns remain elusive and a global picture of brain activation during REMS is currently missing. In the present work, we performed functional ultrasound (fUS) imaging at the whole-brain scale during hundreds of REMS episodes to provide the spatiotemporal dynamics of vascular activity in 259 brain regions spanning more than 2/3 of the total brain volume. We first demonstrate a dissociation between basal/midbrain and cortical structures, the first ones sustaining tonic activation during REMS while the others are activated in phasic bouts. Second, we isolated the vascular compartment in our recordings and identified arteries in the anterior part of the brain as strongly involved in the blood supply during REMS episodes. Finally, we report a peculiar activation pattern in the amygdala, which is strikingly disconnected from the rest of the brain during most but not all REMS episodes. This last finding shows that amygdala undergoes specific processing during REMS and may be linked to the regulation of emotions and the creation of dream content during this very state.

Treatment of Coates retinitis in both eyes in a 5-year-old girl

Purpose. To present a rare clinical case of bilateral Coates retinitis in a 5-year-old girl. Material and methods. A clinical case of a 5-year-old girl with rare Coat's retinitis in both eyes is described. The disease occurred abruptly: the child's parents noted the appearance of leukocoria in the right eye. After the examination Coates ' retinitis was diagnosed. At the time of examination in the clinic, there was a retinal detachment in the right eye, the surgical treatment was performed: lensvitrshvartectomy, plastic surgery of the anterior chamber, with the melting of the retina with perfluoroorganic compounds, drainage of subretinalfluid, endolaser coagulation on the right eye. A month after the first symptoms appeared in the right eye, the patient complained of decreased vision in the left eye. Examination on the pediatric retinal camera showed an increase in vascular activity in the left eye, and signs of Coats' retinitis were revealed. Results. As a therapy for this disease, the patient was twice injected intravitreally inhibitor of vascular endothelial growth factor (VEGF inhibitor) into the left eye with positive dynamics noted as a decrease in the activity of retinal vessels and leveling of the exudative component, as well as with an increase in visual acuity in the left eye. Conclusion. This clinical case demonstrates that intravitreal administration of inhibitor VEGF with traditional methods of treatment can be used as a treatment for patients with Coates retinitis. Key words: Coat's retinitis, Coats' disease, vascular endothelial growth factor inhibitor, aflibercept, intravitreal injection, anti-VEGF, retinal detachment.

55 Frailty Assessment in Lower Limb Critical Limb Ischaemia Patients

Introduction An increasing number of frail older patients are undergoing surgical procedures. Frailty is an independent risk factor for increased hospital stay and adverse postoperative outcomes. This project aimed to assess frailty and its management in lower limb critical limb ischaemia patients on the vascular ward at Manchester Royal Infirmary. Method A prospective review of consecutive admissions admitted with lower limb critical limb ischaemia identified from ward list and vascular activity, and subsequently discharged. Assessment of frailty status using the Edmonton and Rockwood scales within 48 hrs of admission. Results A total of 15 patients were identified with an average age of 69.2 years. The average length of hospital stay was 19 days. 69 total days were spent in the hospital once patients were declared ‘medically fit for discharge’ across all patients. Frailty is associated with increased length of hospital stay and discharge to other institutions. Both the Edmonton and Rockwood scales were congruent in assessing frailty. Conclusions Frailty needs to be assessed and identified early so it can be flagged to therapy services and discharge arrangements commenced early. Measures need to be put in place to manage frailty and reduce the length of hospital stay.

Bilocal osteosynthesis of the tibia with ring fixators in the treatment of nonunions

Background. Bilocal extra-focal osteosynthesis with ring fixators (RF) of tibial nonunion is a method used by some authors. But there are no systematized guidelines for its implementation. This work is devoted to solving this issue. The purpose was to improve the results of the treatment of nonunions of the shin using RF constructions for bilocal osteosynthesis in complex treatment. Materials and methods. Generalized data of treatment of 17 patients with septic nonunions of the shin bones, in the treatment of which the technology of bilocal osteosynthesis with RF was used. According to the Non-Union Scoring System, all cases required complex specialized medical care with a possible positive result (scores from 51 to 75). Bilocal osteosynthesis was part of a complex surgical procedure. The important parts were as follows. The so-called blood-saving tactic was used. We used a squeezing and hemostatic tourniquet, tranexamic acid, and a topically hemostatic sponge. The rings were mounted on solid rods. Semi-closed osteotomy of the anterior and lateral walls was performed from a small incision in a fan-shaped chisel; the posterior wall of the bone was intersected by the levator with a comminuted fracture. Before comparing the reduced fragment with the fragment, they were processed. Conservative therapy was aimed at preventing infection, improving vascular activity, and normalizing metabolic processes. Conclusions. The obtained result of bilocal osteosynthesis of nonunions of the tibia should be considered encouraging and requires further application and study.

Research progress of ghrelin on cardiovascular disease

Ghrelin, a 28-aminoacid peptide, was isolated from the human and rat stomach and identified in 1999 as an endogenous ligand for the growth hormone secretagogue-receptor (GHS-R). In addition to stimulating appetite and regulating energy balance, ghrelin and its receptor GHS-R1a have a direct effect on the cardiovascular system. In recent years, it has been shown that ghrelin exerts cardioprotective effects, including the modulation of sympathetic activity and hypertension, enhancement of the vascular activity and angiogenesis, inhibition of arrhythmias, reduction in heart failure and inhibition of cardiac remodeling after myocardial infarction (MI). The cardiovascular protective effect of ghrelin may be associated with anti-inflammation, anti-apoptosis, inhibited sympathetic nerve activation, regulated autophagy, and endothelial dysfunction. However, the molecular mechanisms underlying the effects of ghrelin on the cardiovascular system have not been fully elucidated, and no specific therapeutic agent has been established. It is important to further explore the pharmacological potential of ghrelin pathway modulation for the treatment of cardiovascular diseases.